A 17-year-old male presented for reversal of a diverting stoma created 1.5 months prior due to acute large bowel obstruction from stool impaction. On examination, the patient's stoma in the left lower abdomen showed no complications and was passing semi-solid stools appropriately. The patient was assessed to have no issues requiring attention prior to stoma reversal due to his history of constipation and emergency surgery.

1. SHORT CASE
PRESENTATION
STUDENT- DR SACHIN SHOLAPUR
GUIDES- DR MILIND RUKE
DR EHAM ARORA

2. gi
A 17 year old male, resident of Mumbai, student by occupation presented to the surgical OPD with chief
complaints of an opening over his abdomen through which he is passing stools and flatus since past 1.5 months
Patient was apparently doing well 1.5 months back when he had vomiting, constipation and pain in abdomen
since 15 days.
Patient c/o acute onset colicky pain in left lower abdomen, non radiating and non referred, not relieved on
medications since 15 days which aggravated in past 1 day.
Pain was associated with acute abdominal distension. He also complained of vomiting of acute onset, bilious,
containing food particles, non projectile and no h/o blood in vomitus.
Patient has history of constipation since birth on regular intervals and passes stools once in every 3-4 days on
straining and using laxatives.
h/o passing hard lumps of stools once in 2-3 days
h/o pain during defecation with bright red blood tinged stools
h/o usage of laxatives and regular enemas for evacuation of the stools
No h/o tenesmus
no h/o mass per abdomen, weight loss
No h/o mass per rectum
Patient was diagnosed of acute large bowel obstruction due to stool impaction and a diversion stoma was made
in left lower abdomen.

3. Patient is passing semisolid stools, yellowish in color, through the stoma since 1.5 months and has now
come for stoma reversal. Patient takes care of the stoma himself, he empties the bag for 2-3 times in a
day and changes a stoma bag once in every 3 days.
h/o passing flatus occasionally and mucoid stools (once) through the anus in past 1 month
no h/o burning sensation, itching around the stoma site
No h/o fever, bleeding, pus discharge from the peristomal area
No h/o protrusion or retraction of the stoma on lying down and standing up
No h/o any parastomal swelling on straining and coughing
No h/o pain in abdomen, vomiting, abdominal distension or recent reduction in stoma output
No h/o excess thirst, drying of mouth or dark urine
No h/o tingling/numbness in the hands and feet
No h/o attending any stoma clinics
No h/o any mental health issues due to the stoma

4. Past history- Not a k/c/o Diabetes mellitus/hypertension/TB/ bronchial asthma
h/o emergency laparotomy with stool evacuation and stoma 1.5 months back
No h/o any other abdominal surgery in the past
Personal history- Diet- mixed
Appetite- unaltered
Sleep- adequate
Bladder- regular
Bowel – passing stools through the stoma and occasional mucus through the anus
non smoker, non alcoholic
Family history- nothing significant
Summary
A 17 year old male, with history of constipation and pain in abdomen since 15 days, leading to evacuation of stools
and creation of stoma in left lower abdomen under emergency setting, presented for stoma reversal with no
complications.

5. Physical examination
General:
Patient is conscious, cooperative and comfortably lying down in supine position
Vitals –
PR- 88/min, right radial artery, regular, good volume
BP- 122/80 mmHg, right arm, supine position
Temp- afebrile
No e/o pallor/icterus/clubbing/cyanosis/koilonychia/lymphadenopathy/oedema
Per abdomen:
Patient was examined in supine and standing position in broad day light with abdomen exposed from the nipples
till mid thigh
Inspection- Abdomen is scaphoid in shape with all quadrants moving symmetrically with respiration
Umbilicus in central, inverted and equidistant from b/l spinoumbilical lines
-Midline laparotomy scar 7x2cm of previous surgery and 1x1 cm scars over b/l iliac fossae.
A single stoma in left iliac fossa with a disposable stoma bag containing yellowish semisolid stools and gas. On
removal of the bag, a double lumen stoma in left iliac fossa about 2 cm lateral to the umbilicus, with yellowish
semisolid stools oozing out from the lateral opening.

6. Both medial and lateral openings are at skin level and have pale pink, rugose mucosa. Cough impulse absent. No
change in size of stoma on standing up.
No e/o parastomal swellings on coughing and straining. Skin around the stoma is normal with patchy
hyperpigmentation
Other Hernial orifices/spine/Groin are unremarkable
Palpation- Abdominal palpation was carried out after proper informed consent
Inspection findings were confirmed

7. Abdomen soft, no local warmth, non tender
No guarding/rigidity
No organomegaly
Stoma palpation shows no tenderness, both openings are palpable and patent
Digital palpation of the lateral intestinal lumen shows stool staining and medial
opening was found to be empty.
No bleeding on palpation.
Percussion- Tympanic note all over abdomen
Auscultation- Bowel sounds present
Per rectal examination-Mucous present, no e/o perianal tags, fissures, haemorrhoids, sinuses
CVS- s1,s2 heard, no murmurs
RS- equal air entry in all areas bilaterally, no added sounds
CNS- conscious, oriented, with no FND

8. SUMMARY AND DIAGNOSIS
A case of temporary decompressing loop sigmoidostomy done for acute intestinal obstruction due to stool
impaction without any stoma related complications
d/d Hirschprung’s disease